CCL injury, conservative or surgery?

[URUGUAY]

I have a young dog that owner noted limping 2 weeks ago. She was going to start some agility with him. He seems to be getting better, but still limping some, mainly when standing up from being lying down for a while.
Gait and Posture:
Lameness on right rear leg on walk grade 1, moving the leg on a lateral circle on the swing phase of the step. Having more difficulty turning on a right circle compared to the left.
The right rear leg is to the side while standing. Sitting with the right leg extended to the side sometimetimes.
Examination:
Not painful on cervical spine palpation. Mild pain on dorso-ventral palpation at T9-11, possible due to compensation for problems on back leg.
Not painful on lumbar spine, but epaxial muscles have increased tone.
Pelvis seems aligned (difficult to evaluate since Jack is shifting his weight to the left).
Right rear leg: no abnormalities/pain on hip joint. Tibial thrust positive on flexion/negative on extension. Not showing pain on manipulation.
Generalized muscle atrophy compared to left rear, mainly quadriceps.
No abnormalities on left rear leg.
There is decreased angle of flexion on both tarsal joints, but no abnormalities on palpation
There is increased tone with myofascial points at left triceps and lattissimus dorsi, no other abnormalities found on both front legs.
Measurements:
Right rear= 16 3/4 inches
Left rear= 17 1/2 inches
Should I try conservative? or do I refer to surgeon? What is the best recommendation considering he may do agility on the future?

[lehughes]

Hey there!

So, it seems that you have found a full tear of the craniomedial band of the cranial cruciate ligament, with the caudolateral band of the CCL remaining intact.
From experience, these are the ones that 'statistically' 'blow' the ligament into a full tear within a year. The longest I had one go on conservative management was 2 years.

I now council people to do the surgery sooner than later. A partial tear of this nature won't fibrose enough to get stability and isn't strong enough to prevent an injury in the future.

The silver lining is that doing the surgery with an intact caudolateral band of the CCL means that there will be more stability after a TPLO (or whatever technique is chosen), and better proprioception (because the CCL has proprioceptive receptors in it.)

So if finances are such that it's possible, then I would suggest just going for the surgery now instead of waiting for the full tear to occur. (Especially if it helps to preserve the meniscus... also a big bonus to have intact!)

Good luck and thanks for the question!

Cheers,

Laurie

[David Lane]

Additional comment: if the surgeon is going to leave the remaining ligament intact, then it needs to be a TPLO; that is the only procedure that has been shown to preserve the remaining ligament. If doing an Ex-cap or TTA, then transect the remaining ligament.